Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit

B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.

B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.

Fried rice is an important cause of emetic-type food poisoning associated with B. cereus.

The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.

Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating such as stir frying.

Two distinct types of toxin–mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.

The emetic syndrome is caused by direct ingestion of the toxin.

The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.

The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one–third of individuals. Symptom onset is usually within one to five hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.

Symptoms usually resolve in 6 to 24 hours.

Rice–based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.

The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.

News Around The Globe

A combination of daclatasvir plus asunaprevir yields high rates of sustained virological response (SVR) in treatment-naive patients with hepatitis C 1B infection, including those with cirrhosis, suggests a multinational phase III trial. The findings were published online in the Lancet.

A new study has shown that use of the protein misfolding cyclic amplification (PMCA) assay could detect PrPSc in 13 of 14 urine samples obtained from patients with variant Creutzfeldt–Jakob disease (CJD). It thus seems possible now to tell with near 100% certainty whether a living patient has variant or sporadic CJD. The study was published in the August 7 issue of the New England Journal of Medicine.

In patients undergoing proctectomy for ulcerative colitis, intramesorectal excision appears to offer only minor advantages over total mesorectal excision, suggests a new study published online in the American Journal of Surgery.

Mammography is often not recommended for women 75 years and older; however, a study published online August 5 in Radiology has shown that it might be beneficial for this age group. Researchers reported that mammography–detected breast cancer in women >75 years has a number of advantages over breast cancer detected by older patients themselves or by their physicians.

New research has suggested that older adults who are tested in the morning –their optimal time of day – perform better on cognitive tasks. Researchers revealed that there are measurable differences throughout the day in brain function for older adults and that older adultsí brain functions work better in the morning. The findings are published in Psychology and Aging.

Rabies News (Dr A K Gupta)

What are the signs of rabies during the prodromal phase in animals?

Prodromal phase may last for 1–3 days and the animal may show only vague CNS signs, which intensify rapidly and death is virtually certain within 10 days after the initial onset of signs.

Cardiology eMedinewS

Results of a novel study have pointed that the majority of men and women at risk for cardiovascular disease, eligible for primary–prevention aspirin therapy, do not receive a recommendation for the drug from their physician. Only 34% eligible men and 42% eligible women recalled receiving a recommendation for the drug from their physician, reported the study published online August 5 in the Journal of General Internal Medicine.

A recent observational study has revealed that the use of fractional flow reserve (FFR) or intravascular ultrasound (IVUS) during PCI is not associated with improved long–term mortality rates when compared with standard angiograph –guided PCI. The findings were published in the August issue of the Journal of American Medical Association: Internal Medicine.

Pediatrics eMedinewS

A study published in Acta Paediatrica has revealed that singing by a mother to her preterm infant while providing ‘kangaroo care’ or holding with direct skin–to–skin contact, brings about improvements in both her child’s and her own health.

Adolescents who behave aggressively are more likely to drink alcohol and in larger quantities than their counterparts while depression and anxiety are not associated with increased alcohol use, suggests a study published in Journal of Adolescence.

Dr K K Spiritual Blog

Types of Memory

The easiest way to remember types of memory is by understanding the concept of Suno, Samjho, Jano and Karo (hearing, listening, knowledge and wisdom). Hearing is the shortest lasting memory. We hear and we forget is the rule.

Once we listen and understand, the memory is longer lasting but the same memory become ever lasting if we not only hear, understand and know but also incorporate the knowledge in our practice.

These principles have been used by marketing people in brand recall. I know many pharmaceuticals play a game and ask 100 doctors to enter into a competition in which they have to write the company’s brand a number of times in one minute and the one who writes the maximum number of times is given a prize. By practicing the brand name repeatedly, you create a permanent impact of their brand in the soul and it is unlikely that you will forget the brand and its recall value will increase every time you think about the molecule.

The same principle has been used by devotees of Rama and Shiva where they make people to write the name of Rama repeatedly everyday and the devotees of Shiva makes people writing the Om Namaha Shivae in a peace of a paper for years together. By doing so you inculcate the teachings of Lord Rama and Shiva.

Many spiritual Gurus give a Mantra, which is also based on the same principle. A mantra is nothing but a positive affirmation which you have to follow every minute of your life throughout your life. Once you start doing it a time will come when it will become a part of your sole consciousness and you will start living and behaving in a way as of your positive affirmation. For example, Brahma Kumaris say that always say a positive affirmation to yourself that I am a peaceful soul. After some time you will start behaving like a peaceful soul and you will lose agitation, anger and negative affirmations of life.

Wellness Blog

Apples during pregnancy and Asthma

Women who eat apples while pregnant may protect their child from developing asthma.

A study showed that children of moms who munched on more than 4 apples per week were 37 percent less likely to have a history of wheezing and 53 percent less likely to have doctor–confirmed asthma, compared to moms who ate one or no apples per week while pregnant. The effect may be due to apple's phytochemical content, such as flavonoids, which have been shown to have beneficial effects on adult lung function.

The study also found that eating fish during pregnancy may curb the risk of eczema in offspring. Children of mothers who ate fish once per week or more while pregnant had a 43 percent lower risk of eczema compared to children whose mothers avoided fish altogether.

High Fat Diet and Breast Cancer

Quoting another study from the National Cancer Institute in Bethesda, Maryland, Dr. Aggarwal said that in middle–aged women, eating a high–fat diet raises the risk of developing invasive breast cancer. There was 32% increased risk of breast cancer among women with a high level of fats in their diet. The risk was seen for all types of fats (saturated, monounsaturated and polyunsaturated) and seemed to be confined to women who were not using hormone replacement therapy. The higher the fat intake, the higher was the risk for breast cancer.

Eat More Fruits

People who eat a diet high in fruit and low in meat reduce their risk of developing colon cancer said Dr. Aggarwal. A team from University of North Carolina in Chapel Hill observed three groups – people who ate a lot of fruit but little meat, people who ate a lot of vegetables and a moderate amount of meat, and people who simply ate a lot of meat. The people who recalled eating large or moderate amounts of meat were 70 percent more likely to have had a polyp than those who said they ate a lot of fruit but little meat. Just 18 percent of the people who said they ate a lot of fruit but little meat had a polyp, compared to 30 percent of the moderate meat–eaters and 32 percent of people in the high meat–eating group.

Inspirational Story

I Wanted to Change the World

When I was a young man, I wanted to change the world. I found it was difficult to change the world, so I tried to change my nation.

When I found I couldn’t change the nation, I began to focus on my town. I couldn’t change the town and as an older man, I tried to change my family.

Now, as an old man, I realize the only thing I can change is myself, and suddenly I realize that if long ago I had changed myself, I could have made an impact on my family. My family and I could have made an impact on our town. Their impact could have changed the nation and I could indeed have changed the world."

Great words for reflection if we rashly attempt to change something or someone else other than ourselves!

ePress Release

All diabetics must have an eye check up done

The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere, said Padma Shri and Dr B C Roy national Awardee Dr K K Aggarwal President Heart Care Foundation of India and National Vice President IMA. Diabetic people with retinopathy are more likely to die of heart disease over the next 12 years than those without it.

The vast majority of diabetic patients who develop diabetic retinopathy (eye involvement) have no symptoms until the very late stages (by which time it may be too late for effective treatment). Because the rate of progression may be rapid, therapy can be beneficial for both symptom amelioration as well as reduction in the rate of disease progression, it is important to regularly screen patients with diabetes for the development of retinal disease.

As per a study from the University of Sydney and the University of Melbourne in Australia and the National University of Singapore, people with retinopathy are nearly twice as likely to die of heart disease as people without it.

People with changes in the eyes may be getting a first warning that damage is occurring in their arteries, and work to lower cholesterol and blood pressure.

Patients with retinopathy have a greater risk of incident cardiovascular disease (CVD) events, including heart attack, stroke, revascularization, and CVD death, compared with those without retinopathy.

Situation: A patient with chest pain with normal ECG died half an hour later. Reaction: Oh my God! Why was acute MI not suspected? Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

Quote of the Day

Don’t waste your life in doubts and fears: spend yourself on the work before you, well assured that the right performance of this hour’s duties will be the best preparation for the hours or ages that follow it. Ralph Waldo Emerson.

eMedinewS Humor

The Coma

The woman’s husband had been slipping in and out of a coma for several months, yet she had stayed by his bedside every single day.

One day, when he came to, he motioned for her to come nearer. As she sat by him, he whispered, eyes full of tears, "You know what? You have been with me all through the bad times.

"When I got fired, you were there to support me."

"When my business failed, you were there."
"When I got shot, you were by my side."

"When we lost the house, you stayed right here."

When my health started failing, you were still by my side. You know what?"

"What dear?" She gently asked, smiling as her heart began to fill with warmth.